重症患者ICU后综合征的发生现状及影响因素研究

doi:10.3761/j.issn.0254-1769.2025.19.008

摘要/Abstract

摘要：

目的探讨重症患者转出1个月后ICU后综合征（post-intensive care syndrome，PICS）的发生现状及影响因素，为制订个性化干预措施提供依据。方法采用便利抽样法，选取2024年4—11月贵州省某三级甲等医院ICU转出1个月的550例患者作为调查对象，收集其一般资料，并在ICU入住期间完成巴氏量表、理查兹—坎贝尔睡眠量表、领悟社会支持量表的测评，在患者转出ICU的1个月后，采用中文版健康老化大脑护理监测问卷通过电话随访的形式完成测评，根据评估结果，将患者分为PICS高危组与无PICS组，采用单因素分析及二元Logistic回归分析其影响因素。结果共发放问卷550份，最终回收有效问卷442份，有效问卷回收率为80.3%。其中，194例（43.9%）为PICS高危患者。二元Logistic回归分析显示，年龄大、肺部感染、总住院时间>15 d、内环境紊乱是ICU转出患者发生PICS的高危因素（P<0.05）。结论重症患者转出1个月后PICS发生风险较高，医护人员需关注年龄较大、肺部感染及内环境紊乱的患者，并针对不同病情类型制订个性化干预措施，以改善患者的预后。

关键词: 重症患者, ICU后综合征, 评估, 影响因素分析, 危重症护理

Abstract:

Objective To explore the current situation and influencing factors of post-intensive care syndrome （PICS） in critically ill patients a month after their transfer out，and to provide a basis for formulating individualized intervention measures. Methods By the convenience sampling method，550 patients who were transferred out of the ICU of a tertiary A hospital in Guizhou Province for a month from April to November 2024 were selected as the survey subjects. The general information of the patients was collected and sorted out. During their stay in the ICU，the Barthel Index，the Richards Campbell Sleep Scale，and the Perceived Social Support Scale were employed for evaluation. A month after the patients were transferred out of the ICU，the assessment was completed through telephone follow-up using the Chinese version of the Brain Care Monitoring Questionnaire for Healthy Aging. According to the assessment a month after the patients were transferred out，they were divided into a PICS group and a non-PICS group. Univariate analysis and binary Logistic regression analysis were completed based on the data of the 2 groups. Results A total of 550 questionnaires were distributed，and 442 valid questionnaires were ultimately collected，with a valid questionnaire collection rate of 80.3%. Among them，194 cases（43.9%） were high-risk patients with PICS. Binary logistic regression analysis showed that advanced age，pulmonary infection，total hospitalization time>15 days，and internal environment disorder were the risk factors for PICS in ICU patients（P<0.05）. Conclusion The risk of PICS is relatively high in critically ill patients a month after the transfer. Medical staff need to pay attention to patients who are older，have pulmonary infections and internal environment disorders，and formulate personalized intervention measures for different disease types to improve the long-term health prognosis of patients.

Key words: Critical Patients, Post-Intensive Care Syndrome, Assessment, Root Cause Analysis, Critical Care

王亭舒, 姚丽, 刘焱, 荆蓓, 李钦钦, 王庭瑞. 重症患者ICU后综合征的发生现状及影响因素研究[J]. 中华护理杂志, 2025, 60(19): 2356-2363.

WANG Tingshu, YAO Li, LIU Yan, JING Bei, LI Qinqin, WANG Tingrui. Research on the current status and influencing factors of post ICU syndrome in severe patients[J]. Chinese Journal of Nursing, 2025, 60(19): 2356-2363.

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参考文献 30

[1]	何曼曼, 江智霞, 张芳, 等. ICU后综合征患者症状特征的潜在类别分析[J]. 中华护理杂志, 2021, 56(10):1445-1452. DOI
	He MM, Jiang ZX, Zhang F, et al. Latent class analysis of symptom characteristics in patients with post-intensive care syndrome[J]. Chin J Nurs, 2021, 56(10):1445-1452. DOI
[2]	Hiser SL, Fatima A, Ali M, et al. Post-intensive care syndrome (PICS):recent updates[J]. J Intensive Care, 2023, 11(1):23.
[3]	Mikkelsen ME, Still M, Anderson BJ, et al. Society of Critical Care Medicine’s international consensus conference on prediction and identification of long-term impairments after critical illness[J]. Crit Care Med, 2020, 48(11):1670-1679.
[4]	孟萌, 关玉珠, 郭利敏, 等. 心血管外科术后患者ICU后综合征风险预测模型的构建及验证[J]. 中华护理杂志, 2022, 57(12):1486-1494. DOI
	Meng M, Guan YZ, Guo LM, et al. Construction of a risk pre-diction model for patients with post-intensive care syndrome after cardiovascular surgery and its prediction effect[J]. Chin J Nurs, 2022, 57(12):1486-1494.
[5]	孙翠玲, 陈春丽, 孙云云, 等. 严重创伤患者发生重症监护后综合征危险因素的meta分析[J]. 中国医药导报, 2024, 21(23):186-191.
	Sun CL, Chen CL, Sun YY, et al. Meta-analysis of risk factors for post-intensive care syndrome in severely traumatized patients[J]. China Med Her, 2024, 21(23):186-191.
[6]	Connolly B, O’Neill B, Salisbury L, et al. Physical rehabilitation interventions for adult patients during critical illness:an overview of systematic reviews[J]. Thorax, 2016, 71(10):881-890. DOI PMID
[7]	Mahoney FI, Barthel DW. Functional evaluation:the barthel index[J]. Md State Med J, 1965, 14:61-65.
[8]	侯东哲, 张颖, 巫嘉陵, 等. 中文版Barthel指数的信度与效度研究[J]. 临床荟萃, 2012, 27(3):219-221.
	Hou DZ, Zhang Y, Wu JL, et al. Study on reliability and validity of Chinese version of Barthel Index[J]. Clin Focus, 2012, 27(3):219-221.
[9]	Richards KC, O’Sullivan PS, Phillips RL. Measurement of sleep in critically ill patients[J]. J Nurs Meas, 2000, 8(2):131-144. PMID
[10]	黄丽, 陈巧玲, 罗利, 等. 中文版重症监护室患者睡眠质量量表的效度与信度[J]. 中国心理卫生杂志, 2018, 32(5):401-406.
	Huang L, Chen QL, Luo L, et al. Validity and reliability of the Chinese version of the Richards-Campbell Sleep Questionnaire[J]. Chin Ment Health J, 2018, 32(5):401-406.
[11]	Dahlem NW, Zimet GD, Walker RR. The Multidimensional Scale of Perceived Social Support:a confirmation study[J]. J Clin Psy-chol, 1991, 47(6):756-761.
[12]	汪向东. 心理卫生评定量表手册[M]. 北京: 中国心理卫生杂志社, 1999.
	Wang XD. Rating scales for mental health[M]. Beijing: Chinese Mental Health Journal Press, 1999.
[13]	Horlait G, Beaudart C, Bougard L, et al. Post-intensive care screening:French translation and validation of the Healthy Aging Brain Care-Monitor,hybrid version[J]. Hea Qua Life Out, 2022, 20(1):59-66.
[14]	彭仁梅. ICU后综合征风险预测模型的构建与验证[D]. 蚌埠: 蚌埠医学院, 2023.
	Peng RM. Construction and verification of risk prediction model for post-ICU syndrome[D]. Bangbu: Bengbu Medical College, 2023.
[15]	曾九华. 急诊重症患者并发ICU后综合征的危险因素分析[J]. 中国医学创新, 2023, 20(2):155-158.
	Zeng JH. Analysis of risk factors of emergency severe patients complicated with post-ICU syndrome[J]. Med Innov China, 2023, 20(2):155-158.
[16]	张习莹, 江智霞, 刘其兰, 等. ICU后综合征患者疲劳轨迹的潜在类别及影响因素分析[J]. 中华护理杂志, 2022, 57(3):272-278. DOI
	Zhang XY, Jiang ZX, Liu QL, et al. Analysis of potential categories and influencing factors of fatigue trajectories in post-intensive care syndrome patients[J]. Chin J Nurs, 2022, 57(3):272-278. DOI
[17]	Lee MJ, Kang J, Jeong YJ. Risk factors for post-intensive care syndrome:a systematic review and meta-analysis[J]. Aust Crit Care, 2020, 33(3):287-294.
[18]	Ito Y, Hamaguchi T, Suzuki M, et al. Identification of unmet information needs among families of critically ill patients and their association with post-intensive care syndrome-family:protocol for a single-center cross-sectional study[J]. BMC Palliat Care, 2025, 24(1):29.
[19]	She SJ, Xu YY. Effect of CICARE communication nursing model combined with motivational psychological intervention in patients with post-intensive care unit syndrome[J]. World J Psychiatry, 2023, 13(9):707-713.
[20]	Liu K, Tronstad O, Flaws D, et al. From bedside to recovery:exercise therapy for prevention of post-intensive care syndrome[J]. J Intensive Care, 2024, 12(1):11.
[21]	Gupta L, Subair MN, Munjal J, et al. Beyond survival:understanding post-intensive care syndrome[J]. Acute Crit Care, 2024, 39(2):226-233.
[22]	Fernández-Gonzalo S, Navarra-Ventura G, Gomà G, et al. Characterization of postintensive care syndrome in a prospective cohort of survivors of COVID-19 critical illness:a 12-month follow-up study[J]. Can J Anaesth, 2024, 71(9):1282-1301.
[23]	Ekong M, Monga TS, Daher JC, et al. From the intensive care unit to recovery:managing post-intensive care syndrome in critically ill patients[J]. Cureus, 2024, 16(5):e61443.
[24]	赵刚, 佀兴旺. 脑外伤术后谵妄及其相关因素分析[J]. 临床医学, 2013, 33(12):53-54.
	Zhao G, Si XW. Analysis of postoperative delirium and its related factors after traumatic brain injury[J]. Clin Med, 2013, 33(12):53-54.
[25]	Flux MC, Lowry CA. Inflammation as a mediator of stress-related psychiatric disorders[M]// Neurobiology of Brain Disorders. Amsterdam: Elsevier,2023:885-911.
[26]	Kinoshita T, Mlodzinski E, Xiao Q, et al. Effects of correction rate for severe hyponatremia in the intensive care unit on patient outcomes[J]. J Crit Care, 2023, 77:154325.
[27]	孙英明, 孙娜, 张敏, 等. ICU转出患者睡眠障碍及其评估工具的研究进展[J]. 中国护理管理, 2020, 20(6):950-955.
	Sun YM, Sun N, Zhang M, et al. Research progress on sleep disorder in post-ICU patients and relevant assessment tools[J]. Chin Nurs Manag, 2020, 20(6):950-955.
[28]	吴秋彦, 邱丹, 肖水源. 新冠肺炎防控常态化期间医务人员睡眠质量与社会支持的关系[J]. 中国心理卫生杂志, 2023, 37(5):442-448.
	Wu QY, Qiu D, Xiao SY. Relationship between sleep quality and social support in medical staff during normalized prevention and control of COVID-19[J]. Chin Ment Health J, 2023, 37(5):442-448.
[29]	Kang J, Cho YS, Lee MJ, et al. Effects of nonpharmacological interventions on sleep improvement and delirium prevention in critically ill patients:a systematic review and meta-analysis[J]. Aust Crit Care, 2023, 36(4):640-649.
[30]	Vlake JH, van Bommel J, Wils EJ, et al. Effect of intensive care unit-specific virtual reality(ICU-VR) to improve psychological well-being in ICU survivors:study protocol for an international,multicentre,randomised controlled trial-the HORIZON-IC study[J]. BMJ Open, 2022, 12(9):e061876.